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      A case of probable oxybutynin-induced increase in liver enzymes

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          Abstract

          We describe the case of a 49-year-old male who presented to the emergency department with right-sided weakness and inability to speak. He was diagnosed with stroke and was admitted to Qatar Rehabilitation Institute after he was treated for the acute phase at Hamad General Hospital. As part of his management, he was started on oxybutynin 5 mg orally twice daily for the treatment of overactive bladder. Within a week, his liver enzymes started to increase. After a thorough medication review, oxybutynin was suspended as it was the only suspected medication to be responsible of this elevation in liver enzymes. When Naranjo Adverse Drug Reaction Probability Scale was used to assess the probability of an adverse drug reaction (ADR), a score of 6 was obtained indicating a “Probable” ADR. In conclusion, this is the first published report of oxybutynin-induced elevation in liver enzymes. Further reports are required to highlight this probable ADR and alert all health professionals about it.

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          Most cited references 13

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          Incidence of drug-induced hepatic injuries: a French population-based study.

          The incidence of hepatic adverse drug reactions (ADRs) remains unknown in the general population. The goal of this population-based study was to assess the incidence and seriousness of hepatic ADRs. All new cases of symptomatic drug-induced hepatic injuries were collected by 139 trained physicians (general practitioners [GPs] and specialists) between November 1997 and November 2000 in an area containing 81,301 inhabitants who could not go elsewhere for medical care. Over 3 years, 34 cases of hepatic ADRs were collected, 82% of them in outpatients. Global crude annual incidence rate was 13.9 +/- 2.4 per 100,000 inhabitants; corresponding standardized annual global rate was 8.1 +/- 1.5. There was no difference between urban and rural areas. Standardized incidence female/male ratio was 0.86 (0.26-2.90) until 49 years of age and 2.62 (1.00-6.92) after this age. Diagnosis was carried out by GPs in half of the cases. The outcome was recovery for 32 patients and death for 2. The main drugs implicated were anti-infectious, psychotropic, hypolipidemic agents, and nonsteroidal anti-inflammatory drugs (NSAIDs). Our results suggest that the number of hepatic ADRs in the French population would be 16 times greater than the number noted by spontaneous reporting to French regulatory authorities. In conclusion, the incidence and seriousness of drug-induced hepatitis are largely underestimated in the general population. These results may be useful for further evaluation of drug-induced hepatotoxicity.
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            Hepatotoxicity associated with statins: reports of idiosyncratic liver injury post-marketing.

            Limited data exist on drug-induced liver injury (DILI) associated with statins. Reports on adverse reactions suspected to be due to statins received by the Swedish Adverse Drug Reactions Advisory Committe 1988-2010 were analyzed. Only cases with >5×upper limit of normal (ULN) in aminotransferases and/or alkaline phosphatase >2×ULN were included. The most common types of ADRs suspected were DILI in 124/217 (57%) cases. A total of 73/124 (59%) cases had at least possible relationship, median age 64 years (57-73), 55% males, whereas 25/124 cases (20%) were excluded due to mild elevations of liver tests and 26 due to unlikely relationship and/or lack of data. A statin-related DILI episode was reported in 1.2/100,000 users. Atorvastatin was implicated in 30/73 (41%) cases, simvastatin in 28 (38%), fluvastatin (15%), and others. Two patients died of acute liver failure, one underwent liver transplantation and 25 (34%) had jaundice. Three patients were rechallenged with the same statin producing similar patterns of liver injury. The median duration of therapy was 90 days (30-120), 120 (39-248) for atorvastatin, and 75 (30-150) for simvastatin (NS). Cholestatic/mixed injury was more common with atorvastatin, 17/30 (56%) than with simvastatin, 7/28 (24%) (p=0.018). Idiosyncratic liver injury associated with statins is rare but can be severe. After recovery, a similar pattern of liver injury can be reproduced on re-exposure. Most patients experience liver injury 3-4 months after start of therapy. Atorvastatin is mostly associated with cholestatic liver injury whereas hepatocellular injury is more common with simvastatin. Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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              The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002.

              The presence of elevated serum aminotransferase activity is a sign of possible underlying liver disease. We aimed to describe the prevalence and associations of elevated serum aminotransferase activity in a recent, nationally representative U.S. survey. We described the prevalence and predictors of elevated alanine aminotransferase (ALT >43 IU/L) or elevated aspartate aminotransferase (AST >40 IU/L) activity among 6,823 participants of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2002. We compared our findings to the results already published based on the NHANES conducted between 1988 and 1994. In NHANES 1999-2002, the prevalences of elevated ALT, AST, or either ALT or AST were 8.9%, 4.9%, and 9.8%, respectively, in the entire population and 7.3%, 3.6%, and 8.1%, respectively, after excluding participants who tested positive for hepatitis C virus (HCV) antibody or reported excessive alcohol consumption. Strong predictors of elevated ALT activity included increasing waist circumference and body mass index, alcohol consumption, male sex, Mexican American ethnicity, decreasing age, and presence of HCV antibody. In NHANES 1988-1994, which employed a different assay methodology, the prevalences of elevated aminotransferases were approximately half of the prevalences we describe in NHANES 1999-2002, but the predictors of elevated ALT activity were similar. The current prevalence of elevated ALT activity in the United States (8.9%) is more than double that of previously available estimates. This prevalence is very high (7.3%) even among persons without viral hepatitis C or excessive alcohol consumption and is strongly associated with risk factors for nonalcoholic fatty liver disease.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                10 September 2018
                : 14
                : 1657-1660
                Affiliations
                [1 ]Department of Pharmacy, Women Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar, halrawashdeh@ 123456hamad.qa
                [2 ]Department of Pharmacy, Qatar Rehabilitation Institute, Doha, Qatar
                [3 ]Department of Physical Medicine and Rehab, Qatar Rehabilitation Institute, Doha, Qatar
                Author notes
                Correspondence: Haneen Alrawashdeh, Hamad Bin Khalifa Medical City (HBKMC), P.O. Box 3050, Doha, Qatar, Tel +974 40 261 680, Email halrawashdeh@ 123456hamad.qa
                Article
                tcrm-14-1657
                10.2147/TCRM.S169868
                6136411
                © 2018 Alrawashdeh et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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